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HomeMy WebLinkAboutMiscellaneous - 47 BONNY LANE 4/30/2018 47 BONNY LANE / 210/062.0-0057-0000.0 ` EWE Address/7'-2 !� y Title of Fire Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to action other Purpose of Document/Action and Document/ document/ notes fWum' Action -Department Board of Appeals - Board of-HealthPlanmm�g Board - Conservation Commission - - Building Department � 1 BOARD OF HEALTHY 146 MAIN STREET ,TELEPHONE# (508) 688-9540 APPLIC.4 TION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEW (SEPTIC SYSTEM) Pursuant to Section. 310 CMR 15.354 of the State Environmental Code, Title V Name ICL A CZt-(n1AA-1 Phone Address 47 i36 AZAN �UJE Contractor (tired for work: Name IKPEA Phone Address 41 J�e,- Date for scheduled abandonment s l The septic system at the above address has been abandoned according to Title V specifications. kLa� E Signature of Contractor Method of septic tank abandonment (check one). ( ) removal ( ) sandfill (50 crush ( ) other Name of Offal Hauler &TCr'M0'!,j This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. /ng7 Inspecting Agent Date 77 om OOOC O 1-800-345-6677 411 Lawrence 688-1181 Haverhill 373-7151 Salem,NH 603-898-1554 Methuen 686-2214 1�—, Andover 475-4711 Newburyport 462-4661 " 'i — / USTGMER'S ORDER NO. H NE M H i• H A N A BILL TO / AK N Y ADDRE S , f �r DAY WORK Y E] CONTRACT ❑ EXTRA JOB NAME AND LOCATION ,, 0000, JOB PHONE 1 �FT5CRIPTi6l,i OF WORK: � ♦fir TOTALAMOUNT Ej No one home E] Total amount due Total billing to Signature for above work:or be mailed after t herebyacknowledge the satisfact Completion 9 orr completion of work of the above described work TERMS; C.O.D. Because of the nature of the work herin described and of Its emergency,we prefer that all payments be made to mechanic on the Job after completion. A FINANCE CHARGE computed at a periodic rate of 1 1/2% PER MONTH which is an ANNUAL PERCENTAGE RATE of 18%will be charged on all accounts remaining unpaid by the 10th of the month following the purchase. THANK YOU. A service charge of$15.00 will apply on all returned checks. 1 !1SEWER SERVICE INC. DATED SE E COMPLETE SEWER-SEPTIC INVOICE SERVICE CUSTOMER NAME © ^ t BILLING ADDRESS (/T (508) 683-5709 (508) 470-1400 Methuen, MA Andover, MA 47 (508) 937-9889 (508) 851-8839 CITY STAT� ZIP PHONE: L' ( Dracut, MA Tewksbury, MA "Nv 444 � � (603) 898-9339 (508)663-6633 JOB ADDRESS IF DIFFERENT THAN BILLING ADDRESS Salem, NH Billerica, MA ADDRESS STATE ZIP DESCRIPTION OF WORK r z I VACUUM PUMP-' SEPTIC TANK GALS. ❑ C ❑ OVERALL SYSTEM ❑ DRYWELL ❑ BASEMENT ❑ FAILED SYSTEM DRAIN LINES CLEANED ❑ MAIN LINE: FT ❑ BATHTUB: FT. ❑ KITCHEN SINK: FT ❑ TOILET BOWL: FT. ❑ FLOOR DRAIN: FT ❑ VANITY: FT. ❑ OTHER LINE: FT. WORK ORDER AUTHORIZATION USE ONLY ON CHARGES GUARANTEES INVOICEAMOUNTS I hereby authorize you to perform the above described services and PARTS $ I agree to pay the amounts indicated to the right. I hereby certify that I am duly authorized to order and approve the work requested. Interest Q 1.5 per month 18%per annum on past due balances. LABOR SIGNATURE TITLE OTHER OTHER TERMS OF PAYMENT TYPE OF VICE TAX EXEMPT CASH ❑ RES/COMM a Ta INDUSTRIAL INDUSTRIAL CHECK CHARGE ❑ PLUMBING ❑ T AL $ 1 JOB COMPLETION I This ' to acknowledge compl ion the above ibed work which has been;don o y m V I Isfac ion. Ih"lrj R DATE U MER IGNATURE SERVIC AN' NA 4. r �. i` 4t '}' r �'��`- ? r•. 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J•r . •;t 1 r t � "�i*x-.:r ` 1�}�`kCr \vycr;„++� �1 i y� ''T k "�f'! �r'• ,�` t r _S t ,�»•i �r ! _ , . • r Dw{a'i5 r �^ Ya; 15 i t }•i t,Y •I.t\ �i!{f A , r• . r �", rx ',t` Y f fit,' r f r,T,a:xt Ir 91� ,�, t��:43 r.,7D n 'd/':� �,t a ��• - - .. i 1 ;� I '.• � :,,rKs �VT ,'' � r,J rq ir.�l,�i�� �Frr .�y, t y �.. �i �r�R� �I r'r� Y> t.- a •• r> � ,r _ a i s � d'S. 2 r •t• , y.' i r[� i Y. '.i'1•., Y, : , rJ ,••ai h� . r. n ��` bt ol pyt'� ,� .rr' ,.rr9_ 1 r �•r' .� �. _ Board oP Realth $f `T'IC SYSfiF,�f North rna - r ss. S h7•L;.T 'I;,, ,,,,;; .IE SP I_{XI` _� ffyID DATE Rini S�F ttj7F,p DAT ! J FAIL OK •— C/ -- J f Ar 1. Distance Tot1000 ✓ ' a. Wetlands b. Drains c. Well .00' / 2. mater Line Location 3• No PPC Pipe 4. Septic Tank-- a. Tees -_Length k To Clean Out Covers - b. Cement Pipe to Tank - Cn Both Sides of Tank Distribution Box a. Covers &_ Box - No Cracks b. All Lines Flowing Equal Amounts ` c. No Back Flow 6. Leach Field or Trezich 01 �a. Dimensions b. Stone Depth c. Capped Ends d. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Stone D - C. SP1 Pads d. T s e./Cement Pipe to Pit -- Both Sides Clean Double Washed Stone j _ 8. No Garbage Di spo sal ! ✓ 9. Yinal Grading Inspection 10. Barricading Covered System 11. As Built Submitted f a. Lot Location b. Dimensions of System c. Location -with Regard-to Perc Test d. Elevations e: Water Table Boaz 4 of Health No fAndover,Mass SUBSURFACE DISPOSAL DESIGN CHMK LIST LOT � DISAPPROVED DATE ►PPR(NED DATE -- Reasons s 'rovideds Pitle V FAIL Seg 2.5 The submitted plan must show as a minimums a) the lot to be served-area dimensions lot #,abutters b location and log deep observation hoies-distance to ties c location and resalts percolation testa-distance -ties area design calculations & calculations showing required f� location and dimensions of system-including reserve area existing and proposed contours g) location any wet areas within 100, of sewage disposal system or • disclaimer-check wetlands mapping (h) surface and subsurface drains within lA0' of sewage disposal � system or disclaimer (1) location any drainage easements within 100' of sesage disposal system or disclaimer-Planning Board files 3) known sources of water supply vi.tbin 2001 Of sewage disposal system or discl,.air►er qk) location of any proposed well to serve lot-100 from leaching facility ) location of water lines on property-10' from leaching facility ) location of benchmark ) driveways. garbage disposals no PVC to be used in construction i e s tic tank (q profile of system-elevations of basement, plumb, p P a a distribution box inlets and outlets, distribution field Piping and father elevations ( ) maxim= ground water elevation in area sewage disposal system s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) c—apacit�es-�50% Of flow, water table, tees, depth of tees, InLr / access, PMP (b) cleanout c) lot from cellar wall or inground sul=ming Pool (d) 25v from subsurface drains . Reg 10.2 / Distribution Boxes ✓ (a) s ope greater 0.08 Reg 10.EF—=,(b) sari zvor_"Ln AnctoverlMa$s SUBSURFACE DISPOSAL DFMCK CHDCK LIST LOT ' tPPROPED DATE DISAPPRapEp DE 'rovidedt Reasonst itle V F eg 2.5 The submitted plan must show as a rdmimumt a) the lot to be served-areas dimensions lot #,abutters location and log deep observation hoes-distance to ties location and results.pe2'colation tests-distance to ties design calculations &_ calculations showing location and dimensions of fired leaching area f existing and -including reserve area g proposed contours g) Location any wet areas Atbin 100, of se a di disclaimer-check wetlands mapping � �08� stem or h) surface and subsurface drains within 100, of sewage disposal system or disclaimer (i) location any drainage easements within 100, of sem a di system or disclaimPi er- $ sposal Planning Board Piles (3) hooka sources of -water supply within 200, of sewage disposal system or disclaimer location of MY proposed well to serve lot-100i ( location of water lines onProperty-3.01 from leaching facility - lines location of benchmark from leaching facility n drive gage disposals no PVC to be used in construction q) profile of system-elevations of basement lumb ' p s Pipes BePtic tank distribution boa inlets and Other elevations outlets, distribution field piping acids maxi mum ground water elevation in area ses,-age disposalstem.— - (s) Plan r► at be prepared by a Professional � professional authorized other by law to prepare suchch plan s 9 6 septic Tanks (a) caacI_H_es___T5o%50g of flow ess , water table,* tees, depth of tees, cleanoutun�� fc) l0, from cellar kall or in-ground skrimdag pool (d) 25' Brom subsurface drains 10.2. Distribution Boxes - 10.4 b)a) Pe greater 0.08 �� i 1 . i 1i - f SEPTIC SYSTEM INSPECTION FORM ADDRESS qrl q�(5 <� DATE INSPECTED h'gPROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS: DYE TEST PERFORMED? Y N DATE? SKETCH: WATERSHED RESIDENTS QUESTIONNAIRE 1. Name 2. Street Address 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool ❑� septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? 5 ' yes ❑ no ❑ do not know 6. How old is your sewage disposal system? ® 0-5 years ❑ 6-10 years ❑ 11-20 years ❑ over 20 years ❑ do not know 7. Has your sewage disposal .system been rebuilt or repaired? ❑ yes Rr no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes no If yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? washing machine vl� dishwasher garbage disposal dehumidifier drain sump pump toilet J roof/pavement drains shower/bathtub _ 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher %-= -'• ` 4- clotheswasher 12. Does your property have a lawn? (R yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre 1/2 acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres li 13. How often do you fertilize your lawn? No. of applications per year Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: ❑ Check here if your lawn is maintained by a professional landscape contractor. TO: �130 , A "D e>j E z— NORTH ANDOVER, MASS. 19�_ ®r- IAF-AL-- VA BOARD OF HEALTH FROM: CQp N DESIGN ENGINEER Re: Soil Absorption `d �Sp�`QTS �� . Sewage Disposal A System This is to certify that I have inspected the construction materials of said disposal system at L—©T f� Y L A o Site Location North Andover, MA. The grades and construction materials are as specified in my plans and specifications dated 19 50 and or-T• z- 19 e>1 LSTReg. Prof. Enginer/Reg. Sanitarian Town of North Andover, Massachusetts Form No. 1 NORTH B(JARD OF {f1EALTH F q 3?0 ��S`ED /646�O0 19 Cl � CO 10 APPLICATION FOR SITE TESTING/INSPECTION 7 AERATED PPP`'� �SSACHUS�� . •�� J r. 1. Applicant NAME / ADDRESS _ TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. S� D.W.C. No. 0 C.C. Date 16Plbg. Permit No./Sv G / — foci